Good urodynamic practices: Uroflowmetry, filling cystometry, and pressure‐flow studies**

Abstract

This is the ¢rst report of the International Continence Society (ICS) on the development of comprehensive guidelines for Good Urodynamic Practice for the measurement, quality control, and documentation of urodynamic investigations in both clinical and research environments. This report focuses on the most common urodynamics examinations; uro£owmetry, pressure recording during ¢lling cystometry, and combined pressure^£ow studies. The basic aspects of good urodynamic practice are discussed and a strategy for urodynamic measurement, equipment set-up and con¢guration, signal testing, plausibility controls, pattern recognition, and artifact correction are proposed. The problems of data analysis are mentioned only when they are relevant in the judgment of data quality. In general, recommendations are made for one speci¢c technique. This does not imply that this technique is the only one possible. Rather, it means that this technique is well-established, and gives good results when used with the suggested standards of good urodynamic practice. Neurourol. Urodynam.21: 261^274,2002. ß 2002 Wiley-Liss, Inc.Key words: urodynamics; standardisation; uro£owmetry; cystometry; pressure-£ow studies INTRODUCTIONA Good Urodynamic Practice comprises three main elements:A clear indication for and appropriate selection of, relevant test measurements and procedureŝ Precise measurement with data quality control and complete documentation Accurate analysis and critical reporting of resultsThe aim of clinical urodynamics is to reproduce symptoms whilst making precise measurements in order to identify the underlying causes for the symptoms, and to quantify the related pathophysiological processes. By doing so, it should be possible to establish objectively the presence of a dysfunction and understand its clinical implications. Thus, we may either con¢rm a diagnosis or give a new, speci¢cally urodynamic, diagnosis. The quantitative measurement may be supplemented by imaging (videourodynamics).Urodynamic measurements cannot yet be completely automated, except for the most simple urodynamic procedure, uro£owmetry. This is not an inherent problem of the measurement itself, but is due to the current limitations of urodynamic equipment and the lack of a consensus on the precise method of measurement, signal processing, quanti¢cation, documentation, and interpretation. With the publication of this ICS Standardisation document on good urodynamic practice, it is expected that the necessary technological developments in automation will follow.Urodynamics allows direct assessment of lower urinary tract (LUT) function by the measurement of relevant physiological parameters. The ¢rst step is to formulate the 'urodynamic question or questions' from a careful history, physical examination, and standard urological investigations. The patient's recordings of micturitions and symptoms on a frequency volume chart, and repeated free uro£owmetry with determination of post-void residual volume provide important noninvasive, objective information that helps to ...

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